HEALTH

Office of the Minister

MLA, Calgary-Acadia

October 16, 2020

His Worship, Naheed Nenshi His Worship, Chris Spearman

Mayor, The City of Calgary Mayor, City of Lethbridge
Historic City Hall City Hall
8069, 700 Macleod Trail South 910 - 4 Avenue S
Calgary AB T2P 2M5 Lethbridge AB T1J 0P6

Her Worship, Tara Veer His Worship, Don Scott, Q.C.

Mayor, City of Red Deer Mayor, Fort McMurray
P.O. Box 5008 7th Floor, 9909 Franklin Avenue
Red Deer AB T4N 3T4 Fort McMurray, Alberta T9H 2K4

Dear Mayor Nenshi, Mayor Veer, Mayor Spearman, and Mayor Scott:

Further to our meeting of September 24, 2020, I want to thank you and your officials for
meeting with Minister Tracy Allard and me to discuss your concerns regarding AHS’
recent decision regarding EMS dispatch in your communities.
Over 10 years ago, EMS (including dispatch) was integrated within our health system
under Alberta Health Services. However, AHS continued to contract dispatch services
from your four municipalities.
Now, after recommendations from the Health Quality Council of Alberta in 2013 and the
AHS Performance Review by Ernst and Young in 2019, AHS has given notice to end
these contracts and integrate EMS dispatch with the rest of the province.
You have asked me to intervene and overturn this procurement decision of AHS.
I thank you for wanting to ensure that all of your concerns were heard by the Alberta
government before AHS continued with transition of the service. I thought it was
important to give you the opportunity to exhaustively discuss your concerns and
questions. As I promised at our meeting, I have carefully reviewed the detailed
information that you shared.
My decision is to not overturn AHS’ decision, and I look forward to supporting them and
your municipalities during the transition to ensure that emergency health services in
your communities can improve.
I want to discuss some of the concerns you raised.

423 Legislature Building, 10800 - 97 Avenue, Edmonton, Alberta T5K 2B6 Canada Telephone 780-427-3665 Fax 780-415-0961

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Decisions of previous health ministers
You pointed out that this decision has been suggested by AHS before, and each time
the minister of the day has blocked it at the urging of municipal leaders. You
characterize this as successfully appealing based on the evidence, and suggest that
you expect the same outcome today. But I must judge by the evidence today, not in the
past; and the plain fact is that dispatch and overall response times are similar across
the province – and within AHS’ targets – in the four cities that dispatch ambulances and
in those that are dispatched by AHS. There is no reason to expect response times to
change.

Medical First Response

You raised questions about the future of medical first response. There seemed to be
some confusion about this service. To be clear, consolidation of EMS dispatch has
nothing to do with medical first response. Fire departments that currently respond to
some medical calls will still do so. Consolidated dispatch won’t affect this at all, as
discussed at the meeting.
We then discussed concerns about process and that EMS dispatch integrated with AHS
would reduce the ability of fire to be dispatched to an ambulance call. One of the many
examples given was the concern that the “twist and shout” method in a dispatch centre
would not be possible in the future.
This is a critical point. While I respect your dedication to your local emergency services,
the claim that safety and efficiency require all dispatchers to be in the same room is out
of date; it ignores how ambulance services have evolved across Canada and in other
countries. Today’s Computer-Assisted Dispatch technology allows multiple services to
be coordinated seamlessly regardless of where the dispatchers physically sit or who
employs them.
The model that we implemented for most of the province in 2009 is the same as in other
provinces: British Columbia, Saskatchewan, Ontario, Quebec, and the four Maritime
provinces all dispatch ambulances from separate centres, as do the UK (National
Health Service), Australia, and New Zealand. The direction is clear across Canada and
globally: ambulances are managed and dispatched as health care resources, and
coordinated with other emergency services without the need for dispatchers to sit in the
same room. (This has of course always been the case for the RCMP.)

The reason for AHS’s decision

You have claimed at various times that the rationale for the change is not clear, so I
want to highlight what Chief Paramedic Darren Sandbeck said in his press conference
in August:
(a) “A province-wide EMS dispatch system will improve patient care through more
efficient coordination of all EMS resources, which allows EMS to send the closest
available ambulance to a patient regardless of geographic boundaries”;
(b) “EMS dispatch also has the ability to involve real-time physician consultation on
emergency calls to ensure patients get the highest quality care when they need it.”
I would also like to clarify that this is not a budget-driven decision. It will result in savings
of several million dollars a year, but not one dollar will be removed from the EMS

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budget. Every dollar AHS saves will be reinvested directly back into improving ground-
ambulance services.
There are clear benefits to this decision, as outlined in previous studies done by the
HQCA as well as EY. All of those documents are public. A provincial integrated model is
a model for now and into the future – it allows modern technology to be leveraged
across the province, and it also allows EMS to practice to their full scope of practice,
including expanding use of community paramedics and ensuring the right resources are
used for inter-facility transfers.

Consultations with AHS

You raised a concern that consultations with AHS have not been sufficient. First, I must
note that “consultation” does not equal a veto. This simple fact has unfortunately been
misconstrued.
I note that it was stated at our meeting that Chief Sandbeck had seen the presentation
you presented to me “hundreds of times.” Regardless, I believed the way to resolve this
concern was to make sure that all four municipalities had the opportunity to meet and
share feedback. I made it clear during our meeting that I was not going to leave the
meeting until everyone had an opportunity to provide all relevant information that I was
to consider. Indeed, your presentation included 43 slides and our meeting was extended
to accommodate your presentation.
At the end of the meeting everyone agreed that they were fully heard, and everyone had
spoken exhaustively about this issue. I therefore see this concern as resolved.

On an “integrated” model
You made the case that dispatch of EMS should be integrated. I agree. The question is
whether it should be integrated with the health system or with fire/police dispatch.
The fact is, government answered this question a decade ago when we integrated EMS
into AHS: patients are best served with paramedics integrated into our health system,
and ambulances dispatched by paramedics – with advice from doctors. (I’m pleased to
advise that beginning in February 2020 we have physician oversight in AHS’s dispatch
centres.)
It was a good decision back in 2009 to create a borderless health system, to provide
consistent services and use resources efficiently. EMS was integrated into AHS for the
same reasons. Every ambulance in Alberta is owned or contracted by AHS; every one
is dispatched using the AHS system. But for whatever reasons, four exceptions were
carved out where city staff dispatch AHS ambulances, using the AHS dispatch system.
This resulted in a fragmented system for just this one part of one service that violates
the point of creating AHS in the first place. As I noted above, those four cities are out of
step not just with the rest of Alberta but with other provinces, and other countries whose
health systems are most like ours. And the fact is, there’s no advantage in response
times from leaving dispatch with the cities, considering the performance of the EMS
system in working with multiple other emergency response agencies across the
province where dispatch has already been integrated. I expect this to be the case in
your areas as well, and will reiterate that response times will not be impacted.

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Dispatch to First Nations
I want to thank Mayor Scott for bringing his concerns about whether the proposed
changes will affect the six First Nations to whom the RMWB dispatches ambulances.
The dispatch of ambulances to all of the indigenous communities in Alberta needs
improvement, and this is a serious concern for me. It is also something the Alberta
government is working to improve for these communities. I can commit to RMWB that
we’ll work to improve dispatch for all of these communities and ensure that any changes
improve the dispatch of ambulances to those six communities.

Mutual Aid Agreements

I also thank Mayor Scott for asking about the Mutual Aid Agreements, as this has also
been brought to my attention by MLAs Yao and Goodridge. AHS assures me that the
MAAs will not be affected by these proposed changes. Thank you for helping our
Ministry to understand the importance of these agreements to your community.

On Chief Sandbeck
I want to respond to concerns that some of you have expressed about Chief Sandbeck,
including the suggestion that the proposed change is “one person’s” decision or vision,
and various personal attacks on him.
This is an AHS decision, now confirmed by government, not a decision of one
individual. I urge you to stick to the evidence and the legitimate interests of the public
and patients, and avoid personalizing the discussion. Chief Sandbeck has dedicated a
40-year career to serving patients in this province, and I will not stand for personal
attacks on him.
I would emphasize that Darren Sandbeck is the province’s Chief Paramedic. This
initiative is driven by the commitment of Chief Sandbeck and EMS to the best interest of
patients. That is the same commitment as your own fire or police chiefs have to their
services and the public; it deserves the same respect.

Conclusion
I have heard it suggested that this change is an unwarranted risk or a “step into the
unknown.” I absolutely reject any such suggestion. The AHS ambulance dispatch
system has served 60% of Albertans since 2009, and it covers the vast majority of the
province’s geographic area. Most other provinces in Canada also dispatch ambulances
separately in a model that integrates EMS with health care, as do the UK, Australia, and
New Zealand. This decision is not “an unknown,” it’s the best practice and the standard
practice in Alberta, in most other provinces, and in other countries whose health
systems are most like ours.
We’ve paid four cities to dispatch ambulances for 11 years now. Ten or 20 years ago,
before CAD, there may have been real advantages to having dispatchers sit in a room
together; there may have been good reasons for cities to fight to keep EMS dispatch.
But there’s just no reason to keep doing it other than protecting the status quo. There’s
no good reason to keep spending $9 million a year on these contracts. That’s $9 million
that should be invested in improving service – not in redundant dispatch. It’s time to
follow through – to integrate dispatch services as intended, leverage AHS’ expertise in
EMS, and direct the savings back into improving ambulance services for patients.

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I want to thank all of you for questions and for the feedback you have provided. I would
also like to thank you for your willingness to listen to the evidence and facts. It’s clear to
me that consolidated EMS dispatch within AHS is the right decision for Albertans. I trust
that the transition will occur seamlessly over the next few months.

Sincerely,

Tyler Shandro, Q.C.

Minister of Health

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